| Jill Marie Buckingham, DTR, LICSW | |
|
3490 Lexington Ave N Ste 205, Shoreview, MN 55126-8044 | |
| (651) 486-3808 | |
| (651) 486-3858 |
| Full Name | Jill Marie Buckingham |
|---|---|
| Gender | Female |
| Speciality | Social Worker - Clinical |
| Location | 3490 Lexington Ave N Ste 205, Shoreview, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235295148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 12099 (Minnesota) | Primary |
| Entity Name | Northeast Youth & Family Services |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1639275852 PECOS PAC ID: 6709788839 Enrollment ID: O20040121000261 |
| Mailing Address | Practice Location Address |
|---|---|
| Jill Marie Buckingham, DTR, LICSW 3490 Lexington Ave N Ste 205, Shoreview, MN 55126-8044 Ph: (651) 486-3808 | Jill Marie Buckingham, DTR, LICSW 3490 Lexington Ave N Ste 205, Shoreview, MN 55126-8044 Ph: (651) 486-3808 |
Hillary Casey, Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 4194 Lexington Ave N, Shoreview, MN 55126 Phone: 651-483-5461 | |
Trisha Lynn Lorraine Sargent, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 3490 Lexington Ave N Ste 205, Shoreview, MN 55126 Phone: 651-379-3414 | |
Bill Bedford, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 3490 Lexington Ave N, #205, Shoreview, MN 55126 Phone: 651-486-3808 Fax: 651-486-3858 | |
Amy Beth Hertle, L.I.C.S.W., L.P. Clinical Social Worker Medicare: May Accept Medicare Assignments Practice Location: 3570 Lexington Ave N, Suite 100, Shoreview, MN 55126 Phone: 651-481-0664 Fax: 651-481-3907 | |
Mr. James William Templeton, MSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 470 Highway 96 W, Suite 280, Shoreview, MN 55126 Phone: 651-484-9554 Fax: 651-484-0703 | |
Jon Mark Fisher, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 3490 Lexington Ave N, Suite 205, Shoreview, MN 55126 Phone: 651-486-3808 Fax: 651-486-3858 |